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This is VAERS ID 679107

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2017

VAERS ID: 679107
VAERS Form:
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 1 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 9/14/2017

VAERS ID: 679107 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 1 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 2/14/2018

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 6/14/2018

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 8/14/2018

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 9/14/2018

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 10/14/2018

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 12/24/2020

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 12/30/2020

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 5/7/2021

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.


Changed on 5/21/2021

VAERS ID: 679107 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Wisconsin
Vaccinated:2016-03-03
Onset:2016-03-04
Submitted:2017-01-23
Entered:2017-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 2 RL / IM
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-03-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: My son was put down for a nap about 12 or a bit after and he never woke up.

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